Bone Tumors and Fractures
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Transcript of Bone Tumors and Fractures
Bone Tumors and Bone Tumors and FracturesFractures
Stacy FieldingStacy Fielding
Primary Bone TumorsPrimary Bone Tumors OSA, CSA, FSAOSA, CSA, FSA SolitarySolitary Metaphyseal locationMetaphyseal location
Long bonesLong bones Rich blood supplyRich blood supply
““Away from elbow, toward Away from elbow, toward the knee”the knee”
Late stage diseaseLate stage disease Invade adjacent bonesInvade adjacent bones Cross jointsCross joints Adjacent parenchymal organsAdjacent parenchymal organs
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Primary Bone TumorsPrimary Bone Tumors AppearanceAppearance
LysisLysis SclerosisSclerosis MixedMixed
Periosteal reactionsPeriosteal reactions Spiculated & fuzzy= Spiculated & fuzzy=
activeactive Smooth & sharp = Smooth & sharp =
inactiveinactive Amorphous = aggressiveAmorphous = aggressive Codman’s triangle Codman’s triangle >>
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Primary Bone TumorsPrimary Bone Tumors Ddx:Ddx:
Fungal osteomyelitisFungal osteomyelitis Bacterial osteomyelitisBacterial osteomyelitis
Consider signalment, Consider signalment, history and clinical history and clinical signssigns
Biopsy to be sure!Biopsy to be sure!
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Metastatic Bone TumorsMetastatic Bone Tumors Tumors that spread to Tumors that spread to
bone:bone: mammarymammary lunglung liverliver thyroidthyroid prostateprostate
Metastatic Bone TumorsMetastatic Bone Tumors Locations:Locations:
metaphysis OR diaphysismetaphysis OR diaphysis vertebrae, ribs, femur, vertebrae, ribs, femur,
humerushumerus Appearance:Appearance:
Similar to primary bone Similar to primary bone tumortumor
Ddx:Ddx: Fungal osteomyelitisFungal osteomyelitis Bacterial osteomyelitisBacterial osteomyelitis HepatozoonosisHepatozoonosis
Approach to FracturesApproach to Fractures Describe direction & locationDescribe direction & location Assess soft tissues Assess soft tissues
open vs. closedopen vs. closed foreign bodyforeign body swellingswelling atrophyatrophy
Joint involvement Joint involvement intra-articular fragmentsintra-articular fragments
Positional changes Positional changes name distal fragment relative to proximalname distal fragment relative to proximal
Look carefully!Look carefully!
Images courtesy of Dr. PackImages courtesy of Dr. Pack
Fracture TypesFracture Types CompleteComplete
Involves both corticesInvolves both cortices Ex) Transverse, oblique, Ex) Transverse, oblique,
spiralspiral Displacement, rotation Displacement, rotation Reduction may be neededReduction may be needed
Incomplete (greenstick)Incomplete (greenstick) One cortex involvedOne cortex involved Bending forceBending force Does not over-rideDoes not over-ride BendingBending
Stress microfracture, fissureStress microfracture, fissure
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Fracture types – cont’dFracture types – cont’d CondylarCondylar
Distal humerus, femur, proximal tibia,Distal humerus, femur, proximal tibia, Medial or lateralMedial or lateral Supracondylar = both fracturedSupracondylar = both fractured V, Y, T = condyles fracture from shaft and each otherV, Y, T = condyles fracture from shaft and each other
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Fracture types – cont’dFracture types – cont’d DepressionDepression
Sinuses or skullSinuses or skull Multiple fissure lines Multiple fissure lines
join and bone collapsesjoin and bone collapses Lucent or sclerotic lineLucent or sclerotic line
AvulsionAvulsion Forceful pull or muscle Forceful pull or muscle
tractiontraction ApophysesApophyses +/- bone segment+/- bone segment
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*Comminuted vs. Multiple*Comminuted vs. Multiple ComminutedComminuted
≥≥33 fracture lines meeting fracture lines meeting at a at a singlesingle pointpoint
High energy traumaHigh energy trauma Butterfly fragmentsButterfly fragments
Multiple/segmentalMultiple/segmental ≥≥3 fracture lines 3 fracture lines not not
meeting at a single pointmeeting at a single point Independent of each Independent of each
otherother
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*Compression vs. Impaction*Compression vs. Impaction CompressionCompression
Crushing injuryCrushing injury Cancellous bone collapsesCancellous bone collapses
Common in vertebraeCommon in vertebrae Shortened bone lengthShortened bone length
ImpactionImpaction Fragment of bone driven Fragment of bone driven
into cancellous boneinto cancellous bone End of long bonesEnd of long bones UncommonUncommon
Salter-HarrisSalter-Harris
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